Manual wheelchair users are at high risk of developing upper limb pain. Recent research and ergonomics literature point to specific propulsion techniques that may prevent injury. The specific aims of this proposal are to 1) Develop wheelchair propulsion-training programs that minimize potential injurious biomechanics; 2) Test if the training programs can cause lasting changes in propulsion biomechanics; and 3) To determine if the addition of real time feedback to a multimedia program is better than a multimedia program alone at improving propulsion mechanics and maintaining improvements over time. The PIs will achieve these aims in a longitudinal controlled trial with a control group, a multimedia group, and a multimedia and real-time feedback group. Training will occur over three weeks and they will follow subjects for three months. The multimedia training will consist of a web-based video that instructs wheelchair users on appropriate technique. The real-time feedback will use a force and moment sensing pushrim to display biomechanics directly to the subjects. During two speed conditions and at intermittent intervals a monitor will provide real-time feedback on either one or a combination of cadence, stroke angle, and velocity during wheelchair propulsion. Kinetic and kinematic analysis will be used to determine training effectiveness both on the target variables and on pushrim forces and joint forces and moments. This study will provide insight into the ability to change wheelchair propulsion biomechanics among chronic wheelchair users. Minimizing cadence and maximizing push angle during wheelchair propulsion may help to minimize injuries and could be the first step in an interventional trial to reduce arm pain in SCI. [unreadable] [unreadable] [unreadable] [unreadable]